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DLPFC-targeted rTMS reduces phantom limb pain and improves psychological comorbidities in traumatic amputees

In a pilot randomized controlled trial, 27 traumatic amputees with phantom limb pain received either real or sham rTMS applied to the dorsolateral prefrontal cortex (DLPFC) for 10 sessions over 2 weeks. Real rTMS was associated with improvements in pain intensity, anxiety, depression, and quality of life compared to sham, suggesting potential as an adjunctive therapy.

Last updated: Aug 26, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score42/100
Human RCT★★☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Effect of DLPFC Targeted rTMS on Phantom Limb Pain and Associated Psychological Comorbidities: A Pilot Randomized Controlled Trial.

observational

Vats D, Bhatia R, Sagar S, Kumar A, Yadav RK, Khan MA, Gulati S, Singh A · Neurorehabilitation and neural repair (2026)

Participants: N/A
Duration: 2 weeks treatment, follow-up at days 15, 30, 60 post-therapy
Intervention: 1Hz rTMS at 90% resting motor threshold applied to DLPFC contralateral to amputation site, 10 sessions over 2 weeks
Outcome: Pain intensity (Visual Analogue Scale), pain quality (Short-Form McGill Pain Questionnaire), anxiety (Hamilton Anxiety Rating Scale), depression (Hamilton Depression Rating Scale), quality of life (WHOQOL-BREF)
Effect Size: N/A
Population: Traumatic amputees with phantom limb pain (n=27)

Result:

PubMed: 42638615DOI: 10.1177/15459683261477087

Mechanism Graph

DLPFC is part of neural circuitry for pain processing and affective aspects of pain
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rTMS induces neuromodulation of DLPFC
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Neuromodulation alters maladaptive cortical plasticity
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Result: Reduced phantom limb pain and improved psychological symptoms

Limitations

  • ⚠Small sample size (n=27) limits generalizability
  • ⚠Pilot study design may not have sufficient power to detect all effects
  • ⚠No long-term follow-up beyond 60 days post-therapy

Frequently Asked Questions

What is DLPFC-rTMS and how does it work for phantom limb pain?▼

DLPFC-rTMS is repetitive transcranial magnetic stimulation applied to the dorsolateral prefrontal cortex. It modulates neural activity in pain-processing circuits, potentially reducing maladaptive plasticity associated with phantom limb pain.

How many sessions of rTMS were given in this study?▼

Participants received 10 sessions over 2 weeks, with 1Hz stimulation at 90% resting motor threshold.

What outcomes were measured in the trial?▼

Primary outcome was pain intensity (VAS). Secondary outcomes included pain quality (SF-MPQ), anxiety (HAM-A), depression (HAM-D), and quality of life (WHOQOL-BREF).

Is DLPFC-rTMS effective for phantom limb pain?▼

The pilot RCT found that real rTMS was associated with improvements in pain, anxiety, depression, and quality of life compared to sham, suggesting potential as an adjunctive treatment, but larger trials are needed.

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References

  1. 1.Vats D, Bhatia R, Sagar S, Kumar A, Yadav RK, Khan MA, Gulati S, Singh A. "Effect of DLPFC Targeted rTMS on Phantom Limb Pain and Associated Psychological Comorbidities: A Pilot Randomized Controlled Trial.." Neurorehabilitation and neural repair, 2026. PMID: 42638615 DOI: 10.1177/15459683261477087
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.